Anonymous cancer metastases in the long bones of the limbs: approaches to the screening and treatment

E.A. Solonitsyn, F.V. Klimovitskiy, V.V. Protsenko

Abstract

The article reports the results of examination and treatment of 50 patients with anonymous cancer metastases in bones. Patients underwent a comprehensive examination: X-ray of the lesion in the bone; X-ray and computed tomography of the chest cavity; ultrasound, computed tomography or magnetic resonance imaging of abdominal organs, retroperitoneal space and pelvis; bone scan; computed tomography or magnetic resonance imaging of the brain; positron emission tomography. To verify the process, an open or punch biopsy of metastatic lesions in bone was performed. Histogenesis of the tumor was determined as follows: in 29 (58 %) patients — glandular cancer, in 15 (30 %) — squamous cell carcinoma, in 6 (12 %) — high-grade cancer. Medical tactic was determined by taking into account the patient’s general condition, localization of metastases, incidence of tumor, metastatic tumor morphological structure, the supposed localization of the primary tumor. In 41 patients with multiple metastases, in cases of severe general condition of the patient and the refusal of the surgery, there was carried out plaster cast immobilization of the limb affected by metastases. Six patients with a relatively satisfactory general state underwent organ-preserving surgeries. In 3 patients, we have performed mutilating surgeries (amputation and disarticulation of the limb). After the diagnostic, conservative and surgical measures, all patients continued comprehensive (chemotherapy, radiation therapy, bisphosphonates) or symptomatic treatment. The chemotherapy regimens in patients with anonymous cancer metastases were chosen according to histological type of tumor. All patients were treated with bisphosphonates (zolendronic acid, pamifos, pamiredin) at intervals of 28 days, from 6 to 10 courses. Radiation therapy was administered to the lesion in the bone in cases of severe pain syndrome and the threat of appearance or presence of pathological fracture to a total focal dose of 40–60 Gray. In the future, patients with anonymous cancer metastases in bones of the skeleton continued examination in order to detect primary malignant tumor.As a result of the treatment, it was found that the life expectancy of patients with anonymous cancer metastases, who received comprehensive treatment, is higher than in patients, whose treatment was limited to symptomatic therapy.